Current Research & Evaluations

 

In 2019, St Vincent’s Homeless Health Service established a program of research focused on the impact of the homeless health service on access to care. 

CURRENT PROJECTS:

Project: Pilot Implementation of the Homeless Health Response Bundle: A phase II hybrid randomised controlled trial.

Team: Jane Currie, Jennie Hutton, Claire Doherty, Andrew Chan, Lee Jones, Alejandro Vasquez Hernandez, Hayley Pepper, Paisley Suggett and Jed Duff.

Background: To improve access to healthcare access for people experiencing homelessness, we developed a Homeless Health Response Bundle, to be used by clinicians in Emergency Departments and Specialist Homeless Services. The Bundle comprises the Homeless Health Access to Care Tool that assesses health-related vulnerability levels (high, moderate, low), and a Decision Assistance Guide to facilitate shared decision-making in regard to treatment and care planning. To test the Bundle, we conducted a phase II hybrid randomised controlled trial to determine the effect of the Homeless Health Response Bundle on reattendances within 28-days to the St Vincent’s Hospital Melbourne Emergency Department. Data collection was completed in September 2023, and we are currently in the process of analysing the data. The results are expected to be published in the second trimester of 2024. 

Related publications:

  • Development of the Homeless Health Access to Care Tool to identify health-related vulnerability among people experiencing homelessness: Delphi study, Australia. Jane Currie, Elizabeth Grech, Erin Longbottom, Jasmine Yee, Ruth Hastings, Amy Aitkenhead, Matthew Larkin, Lee Jones, Amy Cason, Karin Obrecht. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8938696/
  • Multistage psychometric testing of the homeless health access to care tool. Jane Currie, Elizabeth Grech, Jasmine Yee, Amy Aitkenhead and Lee Jones. https://www.mdpi.com/1660-4601/19/23/15928
  • Scoping review of the application of the Behavioural Model for Vulnerable Populations to people experiencing homelessness. Elizabeth Grech, Erin Longbottom, Jasmine Yee, Ruth Hastings, Amy Aitkenhead, Amy Cason, Karin Obrecht and Jane Currie. https://eprints.qut.edu.au/235365/
  • Scoping review of the characteristics assessed by vulnerability indices applied to people experiencing homelessness. Jane Currie, Elizabeth Grech, Erin Longbottom, Jasmine Yee, Ruth Hastings, Amy Aitkenhead, Amy Cason, Karin Obrecht. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254100

Project: Exploring health-related vulnerability among people attending the St Vincent’s Hospital Sydney Emergency Department.

Team: Jane Currie, Matthew Larkin, Alejandro Vasquez Hernandez and Lee Jones.

Background: In this study we aimed to explore the connection between health-related vulnerability and the likelihood of re-attendance within 28-days at an emergency department within a 28-day period. Health-related vulnerability was measured using the Homeless Health Access to Care Tool (HHACT) – a 24 item scale developed by the Homeless Health Research Team. 

In this study, the HHACT was administered to 300 participants (including those in stable and unstable housing) attending the Emergency Department of St Vincent’s Hospital Sydney over a 14-day period during regular business hours. Data collection concluded in October 2023, and we are currently in the process of analysing the data. We anticipate publishing the results in the first half of 2024. 

Project: Feasibility co-design study of the implementation of the Homeless Health Response Bundle to St Vincent’s Hospital Sydney Homeless Health Service.

Team: Jane Currie, Alejandro Vasquez Hernandez, Lee Jones, Jed Duff, Jo River.

Background: In this project we aim to optimise Specialist Homelessness Service response by co-designing, co-evaluation and co-implementation of the Homeless Health Response Bundle.  In October 2023, a co-design team comprising individuals with lived experience and research team members was formed. To date, the Homeless Health Access to Care Tool has been refined by the co-design team, including changes to language and the sequencing of the questions included. In 2024, we will focus on expanding the co-design team to include the key points of contact for each of the St Vincent’s Hospital Sydney, Homeless Health Service teams in which the Bundle will be implemented - Homeless Outreach Team, Assertive Outreach Team, Tierney House, After-hours Team, Community Assessment Team. Thereafter we will co-design the Decision Assistance Guide and the evaluation. Implementation of the Bundle is planned for March 2024. 


Project: Optimising Scope of Practice of Nurses Providing Healthcare to People Experiencing Homelessness: Community Consultation.

Team: Jane Currie, Olivia Hollingdrake, Matthew Larkin, Alejandro Vasquez Hernandez, Julie Gawthorne and Jo River.

Background: This project builds on a national survey of nurses providing care to people experiencing homelessness, follow-up interviews with survey participants and a workforce capacity analysis. The focus of this community consultation is to explore the perceptions of people with lived experience to determine the optimal scope of practice of nurses providing care to people experiencing homelessness. Once identified, the perceptions of people with lived experience will be shared with nurses practising in homeless health services, to garner their reflections on the optimal scope of nurses providing healthcare to people experiencing homelessness. 

Data collection through interviews and focus groups has been underway since September 2022 in Brisbane and Sydney, and will conclude by February 2024.

Related publications:

  • Staff Perceptions of the Potential for Nurses to Address Service Gaps Within a Homeless Health Service in Sydney, Australia: Results of a Cross-sectional Survey (under review). Darcy Morris, Cristina Thompson, Alejandro Vasquez-Hernandez, Matthew Larkin, Lucy McWilliams, Jane Currie.
  • Nurses’ perceptions of the skills, knowledge and attributes required to optimise scope of practice and improve access to care for people experiencing homelessness in Australia: A cross sectional study.  Jane Currie, Lucy McWilliams, Martha Paisi, Jill Shawe, Anna Thornton, Matthew Larkin, Joanne Taylor, Sandy Middleton. https://eprints.qut.edu.au/237973
  • Nurses’ perceptions on the skills, knowledge and attributes required to provide healthcare to people experiencing homelessness in Australia: A qualitative study. Jane Currie, Lucy McWilliams, Vijeta Venkataraman, Martha Paisi, Jill Shawe, Anna Thornton, Matthew Larkin, Joanne Taylor, Sandy Middleton. https://eprints.qut.edu.au/238510

Scoping review: Scope of practice of nurse-led services and access to care for people experiencing homelessness. Lucy McWilliams, Martha Paisi, Sandy Middleton, Jill Shawe, Anna Thornton, Matthew Larkin, Joanne Taylor, Jane Currie. https://onlinelibrary.wiley.com/doi/10.1111/jan.15387


Project: Co-design of a Cooling Hub for People Experiencing Homelessness.

Team: Timothy English, Matthew Larkin, Jo River, Jon Swain, Danielle Austin, Alejandro Vasquez Hernandez Jane Currie

Background: Heatwaves pose a significant public health risk, and people experiencing homelessness are particularly vulnerable to extreme heat and other climate change impacts while sleeping on the street, in vehicles, tents, or substandard housing. In a collaboration between St Vincent’s Hospital, the City of Sydney, University of Sydney, University of Technology and the Queensland University of Technology, we are co-designing and co-evaluating a mobile Cooling Hub to provide respite from extreme heat to those experiencing homelessness in the Sydney LGA. The Cooling Hub will be piloted during the summer of 2023/24 and evaluated using consumer satisfaction and comfort measures, incidence of heat related illness and impact of the Cooling Hub on heat related illness attendances to St Vincent’s Hospital Sydney. 

Related publications:

Media Links:

https://theconversation.com/australias-first-mobile-cooling-hub-is-ready-for-searing-heat-this-summer-and-people-who-are-homeless-helped-design-it-218829?utm_source=linkedin&utm_medium=bylinelinkedinbutton 

How researchers designed Australia’s first mobile cooling hub - The University of Sydney

Australia: People who are homeless designed a mobile cooling system

Sydney free cooling hubs (timeout.com)


Project: Evaluating rehabilitation needs, access and service provision among people experiencing homelessness who have sustained a Traumatic Brain Injury (TBI)

Team: Christine Shiner, Simon Mosalski, Matthew Larkin, Valerie Bramah, Jane Currie, Karon McDonell, Steven Faux and Fiona Haigh.

Background: People who experience homelessness are particularly vulnerable to problems with their physical and psychological health, and international research has identified that approximately half suffer a brain injury at some point in their life. In the broader population, rehabilitation is known to improve health outcomes and promote recovery following brain injury. However, it is not known whether routine rehabilitation services are accessible and adequately used by people who experience homelessness. This project aims to formally evaluate the accessibility and provision of rehabilitation for people experiencing homelessness who have sustained a TBI. We will explore how often those experiencing homelessness would benefit from rehabilitation; what they need from rehabilitation; whether they can access what they need, and/or whether there are certain barriers that prevent them from accessing current rehabilitation services. 

For further info contact Dr Christine Shiner: Christine.shiner@svha.org.au

 

OTHER PUBLICATIONS:

Article Title:  Optimising Access to the COVID-19 Vaccination for People Experiencing Homelessness.

Team: Jane Currie, Olivia Hollingdrake, Elizabeth Grech, Georgia McEnroe, Lucy McWilliams and Dominic Le Lievre.

Abstract:
People experiencing homelessness face challenges accessing vaccinations. The urgency of the Australian COVID-19 national vaccination program requires an ongoing, integrated, and collaborative approach to ensure that people experiencing homelessness are supported to access COVID-19 vaccination in a culturally appropriate way that fosters a sense of safety by acknowledging people’s sense of cultural identity. As of 30 July 2022, 20,160,781 (78.3%) people aged 16 years and over in Australia have received at least one COVID vaccine dose, and 19,817,623 (77.0%) have received two doses, and 14,095,910 (54.85) have received three. Once vaccination became available, the Australian Government developed a three-phase national roll-out strategy. In Phase 1a the strategy focused on frontline health workers, aged care and disability staff and residents, and quarantine and border workers. Thereafter, elderly adults, other health workers, Aboriginal and Torres Strait Islander people (The Torres Strait Islands stretch between the coast of Northern Australia and Papua New Guinea, with Indigenous populations that are distinct from those of Australia’s mainland) and then reaching adults aged 60–69 and the balance of the population. The final phase focused on those under the age of 18 years old. In response to the national rollout, leaders in the provision of homeless health services became concerned that those experiencing homelessness may be at greater risk of exposure to COVID-19 due to their inability to self-isolate in a dwelling. Plans were made to establish a vaccine hub specifically focused to people experiencing homelessness. In this paper, we report the findings of a study that explored the model of care underpinning the homeless health Inner City COVID-19 Vaccine Hub in Sydney Australia. These findings can be used as a template to assist other services to optimize access to vaccinations for people experiencing homelessness.

Link: IJERPH | Free Full-Text | Optimizing Access to the COVID-19 Vaccination for People Experiencing Homelessness (mdpi.com)

Blueprint model of care to support vaccine hubs for people experiencing homelessness: The purpose of this document is to offer guidance to other agencies in the development and delivery of vaccine hubs for people experiencing or at risk of homelessness. The model of care described here is also relevant to vaccination efforts targeting other hard  to reach or marginalised people and communities. https://apo.org.au/node/314543


For additional information about any of the projects, please contact Dr Jane Currie at jane.currie@qut.edu.au